Stress Health Article

STRESS

Over the course of evolution, the human mind and body have developed means of handling stressful situations. Over the short term, such stress response pathways are highly adaptive, allowing a person to manage his or her resources in order to navigate the crisis; in some cases, however, these processes go awry and result in pathology. Chronic stress is becoming increasingly problematic in the United States as workers work longer and harder hours. Approximately one-third of all workers report that they are in high-stress jobs, and that not only is stress implicated in 15 percent of all disability claims, the number of stress-related absences is increasing. Such prolonged exposure to stress can also result in consequences in the form of physical illness. Alternatively, a severe acute stressor may result in a stress-response syndrome such as an acute stress disorder or a post-traumatic stress disorder.

In acute stress, the mind and body respond with a fight or flight response that involves activation of the sympathetic nervous system and release of stress hormones such as cortisol. Psychologically, this increases the organism's alertness and response time. Physiologically, these changes provide the organism with the energy needed to meet the emergency. Such intense activation helps the organism in the short term, but prolonged activation of this system creates problems in that it may increase the risk of certain disease states, and, once set into motion, chronic stress responses may be difficult to extinguish. This has led some researchers to investigate potential mediating factors such as personality. For example, a correlation has been established between a personality characterized by hostile competitiveness (type A) and increased risk of myocardial infarction (heart attack).

An acute stressor or psychological trauma, such as a life-threatening circumstance, presents a person with new information that may be difficult to assimilate. In an attempt to adapt, the person will typically alternate between contemplation of the stressor and avoidance of reminders of the event. Such a cycle allows for dose-by-dose psychological processing of the event. Difficulties in adaptation may present as an acute stress disorder that manifests itself as an extreme version of this cycle. People with such a disorder may have intrusive remembrances, nightmares, or even flashbacks of the stress event. These can alternate with emotional numbing, interpersonal alienation, and extreme avoidance of traumatic reminders. A diagnosis of postraumatic stress disorder (PTSD) is made if these symptoms persist longer than one month. Studies suggest that approximately 0.5 percent of men and 1.3 percent of women meet criteria for PTSD over their lifetime. A larger percentage (approximately 15%) of subjects were found to have some symptoms but did not meet criteria for the full disorder.

At present, psychotherapy is the mainstay of treatment for stress response syndromes. A variety of approaches exist, but they share a common goal of assisting the patient with conscious contemplation of the event in such a way that it may be assimilated and anxiety responses extinguished. Care must be taken to create an environment of safety and to avoid retraumatization, which may occur with overly rapid exposure to traumatic memories. Patients experience decreased feelings of guilt and shame as they learn that they responded to the trauma as adequately as possible. Contemplation of the event in therapy may lead to further benefits, including an enhanced understanding of the meaning of the event in the larger context of the individual's life.

Psychopharmacologic treatment may be a useful adjunct for specific symptom clusters such as associated anxiety, depression, and insomnia. The prognosis for treatment is good and is improved if the patient was without preexisting psychiatric comorbidity and if the treatment occurs in close proximity to the event. Brief treatment is frequently helpful in restoring a patient to a baseline level of functioning, but longer-term treatment may be necessary if exposure to the stressor was chronic or occurred in childhood.

Stress response systems have developed in humans as an adaptive mechanism to assist individuals in times of crisis. These systems, however, may also result in physical or psychological pathology. Chronic overactivation of the stress response may predispose an individual to greater risk for physical illnesses such as heart disease. Overly intense exposure to an acute stressor may result in a stress response syndrome with potentially disabling consequences. Treatment is, however, available and may return individuals to their previous level of functioning. A subset of patients even report a sense of enhanced insight into their lives as a result of the trauma.

JAMES POWERS

STUART J. EISENDRATH

(SEE ALSO: Mental Health)